耐万古霉素屎肠球菌血流感染发生与死亡的影响因素分析

Influencing factors for vancomycin-resistant Enterococcus faecium bloodstream infection and death

目的通过对医院近年来屎肠球菌血流感染临床诊治和耐药情况的分析,探讨万古霉素耐药屎肠球菌(VREfm)血流感染发生和死亡的影响因素。方法回顾性分析医院2011年1月-2016年12月共71例屎肠球菌血流感染的病例资料,收集患者的人口学资料、入住病区、有创操作、细菌药敏结果、基础疾病、预后情况等资料;通过多因素Logistic回归分析确定独立危险因素。结果 71例屎肠球菌血流感染患者中,万古霉素耐药屎肠球菌血流感染者占比高达29.6%(21例)。之前90天内使用万古霉素是VREfm血流感染的独立危险因素(P<0.001)。肝功异常是屎肠球菌血流感染死亡的独立危险因素(P=0.043)。结论万古霉素耐药屎肠球菌血流感染发生率高。发病前90天内使用万古霉素是VREfm血流感染发生的独立风险因素,临床应加强对万古霉素等糖肽类抗菌药物的使用管理。肝功异常是屎肠球菌血流感染死亡的独立危险因素。

OBJECTIVE To investigate the clinical diagnosis and treatment of Enterococcus faecium bloodstream infection in recent years,analyze the drug resistance,and explore the influencing factors for vancomycin-resistant E.faecium bloodstream infection and death.METHODS The clinical data of the 71 patients with E.faecium bloodstream infection who were treated in the hospital from Jan 2011 to Dec 2016 were retrospectively analyzed.The data,including the demographic data,inpatient wards,invasive procedures,results of drug susceptibility testing,underlying diseases and prognosis,were collected from the patients.Multivariate logistic regression analysis was performed to determine the independent risk factors.RESULTS Of the 71 patients with E.faecium bloodstream infection,21(29.6%)had vancomycin-resistant E.faeciumbloodstream infection.The use of vancomycin within 90 days was the independent risk factor for the vancomycin-resistant E.faecium bloodstream infection(P<0.001).Abnormal liver function was the independent risk factor for the death of the patients with E.faecium bloodstream infection(P=0.043).CONCLUSION The incidence of vancomycin-resistant E.faecium bloodstream infection is high.The use of vancomycin within 90 days before the attack was the independent risk factor for the vancomycinresistant E.faecium bloodstream infection.It is necessary for the hospital to strengthen the management of glycopeptides antibiotics such as vancomycin.The abnormal liver function is the independent risk factor for the death of the patients with E.faecium bloodstream infection.